DEVON M FORTELKA Athletic Trainer License verification

Business Entity

INACTIVE

License Type

Athletic Trainer

Description

LICENSED ATHLETIC TRAINER

License Number

096003470

License Status

INACTIVE

Business

First Name

DEVON

Middle

Last Name

FORTELKA

Business Name

DEVON M FORTELKA

Original Issue Date

10/16/2012

Effective Date

05/30/2014

Expiration Date

05/31/2016

City

LAKE ZURICH

State

Zip

60047

County

LAKE

Ever Disciplined

LastModifiedDate

03/07/2016